中文摘要：

目的通过分析血清高尔基体蛋白73（Golgi protein 73,GP73）及3种常用纤维化评分（Fibrotest、APRI、S指数）无创评估慢性乙型肝炎患者显著肝纤维化的临床价值,探索新的肝纤维化无创诊断指标。方法选取2013年3月-2014年6月经肝活检证实的慢性乙型肝炎患者148例,检测所有患者血清GP73和其他实验室指标,计算Fibrotest、APRI、S指数等3种评分,所有患者肝脏纤维化程度按Scheuer系统标准分为轻度肝纤维化组80例（S0-S1）,显著肝纤维化组68例（S2-S4）,比较两组患者血清GP73及3种纤维化评分的差异,并采用ROC曲线评价血清GP73及3种纤维化评分单项及联合应用对显著肝纤维化的诊断价值。结果显著肝纤维化组患者的血清GP73及3种纤维化评分均显著高于轻度肝纤维化组患者,差异有统计学意义（P〈0.01）,且血清GP73与肝脏纤维化程度、Fibrotest、APRI、S指数均有较好的相关性;血清GP73、Fibrotest、APRI、S指数诊断显著肝纤维的ROC曲线下面积（AUC）分别为0.750、0.743、0.665、0.661,95%CI分别为0.672-0.817、0.665-0.812、0.583-0.740、0.579-0.737;单项指标中血清GP73的诊断价值最好,AUC达到0.750,以108ng/ml为截点,其预测的敏感性和特异性分别为67.60%和80.00%;对血清GP73及3种常用纤维化评分评分进行多因素logistic回归分析构建联合预测模型,其AUC达到0.813。结论血清GP73对慢性乙型肝炎患者明显肝纤维化的预测有一定的临床应用价值,与其他无创诊断指标联合应用可以提高预测的准确性。

英文摘要：

OBJECTIVE To analyze the clinical value of serum Golgi Protein 73（GP73）and three common score systems（Fibrotest,APRI and S index）in noninvasive assessment of significant 1iver fibrosis in patients with chronic hepatitis B,so as to explore a new marker for the noninvasive diagnosis of 1iver fibrosis.METHODS Totally 148 patients with chronic hepatitis B from Mar.2013 to Jun.2014 had undergone 1iver biopsy.Serum GP73 and other laboratory markers were measured,and the score of Fibrotest,APRI and S index was calculated based on the serum marker.Liver fibrosis stages were divided into S0-S4 according to the Scheuer scoring system,80 patients with fibrosis stage（S0-S1）was identified mild 1iver fibrosis,and 68 patients with fibrosis stage（S2-S4）was identified significant 1iver fibrosis.The difference between the above two groups was compared and the diagnosis value of serum GP73 and three score systems alone or combined for significant 1iver fibrosis was evaluated by receiver operating characteristic curve（ROC）.RESULTS The concentration of serum GP73 and the score of three score systems in significant 1iver fibrosis were much higher than those in mild 1iver fibrosis（all P〈0.01）.A significant linear correlation was found between serum GP73 and the stage of fibrosis,as well as Fibrotest,APRI and S index.The area under the ROC of serum GP73 and three score systems for the diagnosis of significant 1iver fibrosis were 0.750（0.672-0.817）,0.743（0.665-0.812）,0.665（0.583-0.740）,0.661（0.579-0.737）respectively.Among them,serum GP73 has the best diagnosis value.When the cut-off value of serum GP73 was set at 108ng/mL,the sensitivity and specificity were 67.60% and 80.00%.The area under the ROC of the combined prediction model established by logistic regression was 0.813.CONCLUSIONSerum GP73 has some clinical value in noninvasive assessment of 1iver fibrosis for patients with chronic hepatitis B,and the prediction accuracy can be improved combined with other noninvasive indexes.